1.2.1 Increased risk of transmission
‘The effects of poverty, powerlessness and social instability are intensified in an emergency situation, increasing people's vulnerability to HIV/AIDS.'
Source: World Food Programme 2004. HIV/AIDS & emergencies: Compounding crises.
Humanitarian crises and emergencies can create situations or conditions that heighten an individual’s risk to HIV. The emergency situation creates the following conditions that increase the risk of HIV transmission among the population:
- During a crisis, the effects of poverty, powerlessness and social instability are intensified, which increases vulnerability to HIV/AIDS.
- As social networks and livelihoods collapse due to emergencies and conflicts, people are subjected to situations with a high risk of HIV.
- Emergencies can lead to the fragmentation of families and communities, which threatens stable relationships. When social norms that regulate behaviour are weakened, women and children are at increased risk of violence, and can be forced into having unsafe sex to gain access to basic needs, including security.
- Loss of livelihoods and income may force women into transactional or commercial sex.
- Evidence demonstrates that the incidence of rape and gender-based violence increases during emergencies (refer also to Chapter Gender).
- Displacement may bring populations, each with different HIV/AIDS prevalence levels, into contact, especially in the case of populations migrating to urban areas to escape conflict or disaster.
- Emergencies place stress on health infrastructure, and inadequate supplies hamper HIV/AIDS prevention efforts. An inadequacy of services facilitates HIV/AIDS transmission through lack of precautions, unavailability of condoms, limited access to treatment for sexually transmitted infections and contaminated blood.
- The presence of military forces, peacekeepers or other armed groups contributes to increased transmission of HIV/AIDS through forced sexual activity. Women seldom have control over sexual negotiation or the relationship.
- The breakdown of school, health and communication systems, which are usually used to programme against HIV transmission, increases the risk of transmission in emergencies.
- Pregnant women and newborns are often unable to access services critical to preventing vertical transmission of HIV (including VCT, prophylaxis and education on breastfeeding).